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Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections.

The Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients).

The results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin.

While the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics.

Employing the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs.

There is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies.

Facilitation activities support implementation of evidence-based interventions within healthcare organizations. Few studies have attempted to understand how facilitation activities are performed to promote the uptake of evidence-based interventions in hospitals from resource-poor countries during crises such as pandemics. This paper aims to explore facilitation activities by infection prevention and control (IPC) professionals in 16 hospitals from 9 states in Brazil during the COVID-19 pandemic.

Primary and secondary data were collected between March and December 2020. Semi-structured interviews were conducted with 21 IPC professionals in Brazilian hospitals during the COVID-19 pandemic. Public and internal documents were used for data triangulation. The data were analyzed through thematic analysis technique.

Building on the change response theory, this study explores the facilitation activities from the cognitive, behavioral and affective aspects. The facilitation activities are grouped in three overarching dimensions: (1) creating and sustaining legitimacy to continuous and rapid changes, (2) fostering capabilities for continuous changes and (3) accelerating individual commitment.

During crises such as pandemics, facilitation activities by IPC professionals need to embrace all the cognitive, behavioral and affective aspects to stimulate positive attitudes of frontline workers toward continuous and urgent changes.

This study provides unique and timely empirical evidence on the facilitation activities that support the implementation of evidence-based interventions by IPC professionals during crises in hospitals in a resource-poor country.

The coronavirus disease 2019 (COVID-19) pandemic has been reported to have a major impact on the mental health of an individual. Healing the mental stress, anxiety, depression and insomnia of an individual's immediate surroundings play a major role. Therefore, this study reviews how the built environment impacts the healing of an individual's state of mind.

Various works of literature on healing environments were analysed to create frameworks that can facilitate psychological healing through architectural elements. Articles were selected from various journals like SAGE, PubMed, Journal of Applied and Computational Mechanics (JACM), Routledge Taylor and Francis, Journal of Contemporary Urban Affairs (JCUA), ScienceDirect, and Emerald databases, news articles, official web pages, and magazines that have been referred.

Indicators (spatial, sensory comfort, safety, security, privacy and social comfort) are linked to sub-indicators (access, distractions and views) and design characteristics (indoor climate, interior view, outside view, privacy, communication, noise, daylighting, temperature) which help in better connection of the built environment with individual's mental health. From the above indicators, sub-indicators and design characteristics, the authors have come to a conclusion that a view to the outside with better social interaction has an in-depth effect on an individual's mental health.

This study predominantly talks about healing in hospitals but quarantining of COVID-19 patients happens in residences too. So, it is important to find the healing characteristics in residences and in which typology the recovery process is high.

This paper has been written completely by the author and the co-authors and has not been copied from any other sources.

The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).

The methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.

The authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.

The methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.

As the world faces a new health crisis threatening people with the spread of Covid-19, this study aims to summarize the key information of Covid-19 related to disease characteristics, diagnosis, treatment and prevention along with the lessons learned from Thailand.

The narrative review was synthesized from various sources such as the World Health Organization; Centers for Disease Control and Prevention; Ministry of Public Health and other related news; articles in ScienceDirect, PubMed, Google Scholar; and the author's perspective regarding the lessons learned from Thailand with keywords of “Covid-19” and “Coronavirus” from January to August 2020. Google Trends was used to set common questions.

Covid-19 is the seventh family of coronaviruses that cause various symptoms related to respiratory systems. The disease can be treated through general and symptomatic treatment, by using antiviral drugs. As of July 2020, there are four potential vaccine candidates ChAdOx1 nCoV-19, mRNA-1273, Ad5-nCOV and BNT162b1. The recommendations for Covid-19 prevention are physical distancing, face masks, eye protection and hand washing. Thailand is now considered as low-risk for Covid-19 possibly because of (1) soft policy by government actions, (2) village health volunteers, (3) integration of technology and (4) fact-based communications.

This study summarized the key points about Covid-19, clarified some misunderstandings and shared strategic actions from Thailand, which can be adapted according to the different capacities and situations in other countries.

One of the biggest challenges in the health sector is that of costs compared to economic resources and the quality of services. Hospitals register a progressive increase in expenditure due to the aging of the population. In fact, hip and knee arthroplasty surgery are mainly due to primary osteoarthritis that affects the elderly population. This study was carried out with the aim of analysing the introduction of the fast track surgery protocol, through the lean Six Sigma, on patients undergoing knee and hip prosthetic replacement surgery. The goal was to improve the arthroplasty surgery process by reducing the average length of stay (LOA) and hospital costs

Lean Six Sigma was applied to evaluate the arthroplasty surgery process through the DMAIC cycle (define, measure, analyse, improve and control) and the lean tools (value stream map), adopted to analyse the new protocol and improve process performance. The dataset consisted of two samples of patients: 54 patients before the introduction of the protocol and 111 patients after the improvement. Clinical and demographic variables were collected for each patient (gender, age, allergies, diabetes, cardiovascular diseases and American Society of Anaesthesiologists (ASA) score).

The results showed a 12.70% statistically significant decrease in LOS from an overall average of 8.72 to 7.61 days. Women patients without allergies, with a low ASA score not suffering from diabetes and cardiovascular disease showed a significant a reduction in hospital days with the implementation of the FTS protocol. Only the age variable was not statistically significant.

The introduction of the FTS in the orthopaedic field, analysed through the LSS, demonstrated to reduce LOS and, consequently, costs. For each individual patient, there was an economic saving of € 445.85. Since our study takes into consideration a dataset of 111 patients post-FTS, the overall economic saving brought by this study amounts to €49,489.35.

The study's aims are to identify healthcare innovation variables, explore innovative work behavior’s (IWB's) influence on Saudi health sector companies and evaluate the mediating function of transformational leadership in the link between IWB and healthcare organizations. In this backdrop, the purpose of the current research was to investigate the impact of creative work behavior on organizational performance and the role of transformational leadership in this process.

The objective of this quantitative cross-sectional study was to examine, according to 587 participants, the perceived elements of creative work behavior (RQ1). In various 10 departments of the 5 Dammam Health Network (DHN) in the Eastern Province of Saudi Arabia, online questionnaires were used to collect data. SmartPLS 3 software was used to analyze the data.

The findings indicated that healthcare professionals perceive the elements of autonomy, competence, relatedness, motivation and knowledge sharing as key features that influence high efficiency in organizational efficiency (p < 0.001). IWB also had a significant and direct positive influence on organizational performance (p < 0.001). Transformational leadership behavior had an insignificant negative effect on employees’ task performance when considering organizational performance (P = 0.122). Therefore, the mediation role did not affect the relationship with IWB concerning employees’ task performance, suggesting that transformational leadership behaviors did not have a mediating effect on the effectiveness of employees’ task performance.

This article contains original analysis and interpretation highlighting integrating IWB and transformational leadership into Saudi Arabia's national healthcare system that can help address specific difficulties facing healthcare practitioners.

The reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues.

Lean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems.

The corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified.

The follow up and the satisfaction of patients were not analyzed and could be a future development of this study.

Patients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management.

The introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs’ with a money saving of more than 50,000 euro per year.

This survey explores the application of real options theory to the field of health economics. The integration of options theory offers a valuable framework to address these challenges, providing insights into healthcare investments, policy analysis and patient care pathways.

This research employs the real options theory, a financial concept, to delve into health economics challenges. Through a systematic approach, three distinct models rooted in this theory are crafted and analyzed. Firstly, the study examines the value of investing in emerging health technology, factoring in future advantages, associated costs and unpredictability. The second model is patient-centric, evaluating the choice between immediate treatment switch and waiting for more clarity, while also weighing the associated risks. Lastly, the research assesses pandemic-related government policies, emphasizing the importance of delaying decisions in the face of uncertainties, thereby promoting data-driven policymaking.

Three different real options models are presented in this study to illustrate their applicability and value in aiding decision-makers. (1) The first evaluates investments in new technology, analyzing future benefits, discount rates and benefit volatility to determine investment value. (2) In the second model, a patient has the option of switching treatments now or waiting for more information before optimally switching treatments. However, waiting has its risks, such as disease progression. By modeling the potential benefits and risks of both options, and factoring in the time value, this model aids doctors and patients in making informed decisions based on a quantified assessment of potential outcomes. (3) The third model concerns pandemic policy: governments can end or prolong lockdowns. While awaiting more data on the virus might lead to economic and societal strain, the model emphasizes the economic value of deferring decisions under uncertainty.

This research provides a quantified perspective on various decisions in healthcare, from investments in new technology to treatment choices for patients to government decisions regarding pandemics. By applying real options theory, stakeholders can make more evidence-driven decisions.

Decisions about patient care pathways and pandemic policies have direct societal implications. For instance, choices regarding the prolongation or ending of lockdowns can lead to economic and societal strain.

The originality of this study lies in its application of real options theory, a concept from finance, to the realm of health economics, offering novel insights and analytical tools for decision-makers in the healthcare sector.

This study addresses the COVID-19 infection and its relationship with the city’s constructive intensity, commuting time to work and labor market dynamics during the lockdown period.

Microdata from formal workers in Recife was used to adjust a probability model for disease contraction.

The authors' results indicate that greater distance to employment increases the probability of infection. The same applies to constructive intensity, suggesting that residences in denser areas, such as apartments in buildings, condominiums and informal settlements, elevate the chances of contracting the disease. It is also observed that formal workers with completed higher education have lower infection risks, while healthcare professionals on the frontlines of combating the disease face higher risks than others. The lockdown effectively reduced contagion by limiting people’s mobility during the specified period.

The research shows important causal relationships, making it possible to think about public policies for the health of individuals both when commuting to work and in living conditions, aiming to control contagion by COVID-19.

The lockdown effectively reduced contagion by limiting people’s mobility during the specified period.

It is also observed that formal workers with completed higher education have lower infection risks, while healthcare professionals on the frontlines of combating the disease face higher risks than others.

The authors identified positive and significant relationships between these urban characteristics and increased contagion, controlling for neighborhood, individual characteristics, comorbidities, occupations and economic activities.